I first was introduced to ED back in 1996. I had just finished graduate school and took a part time job at an eating disorder program. As a dietitian, my main interest was in health promotion and disease prevention. It made sense to me that it seemed smarter and easier to help people prevent disease if possible through promoting a healthy lifestyle. It is much harder to treat illnesses that may have been prevented. I specifically remember a middle aged man who I met during my very first job as a dietitian in a small hospital. He was admitted after having a heart attack. His lifestyle was not healthy at all (smoking, unhealthy diet, no physical activity). I remember thinking that he should not have been there.
I left the hospital after just one year and changed my focus to helping people be healthy. I worked for WIC (Women, Infants and Children) and loved teaching young mothers about healthy eating. I also did some private practice and that is when I knew I needed more skills with counseling, and went back to graduate school (with a focus on counseling). It was while working on the college campus that I encountered students with “sub-clinical” eating disorders. In other words, they were restrained eaters who dieted yet had not developed an eating disorder yet. I did my research on “cognitive restraint” because I felt if we could stop people from dieting and focus on health instead, we could possibly prevent an eating disorder.
Although working with eating disorders was something I never planned to do, after doing my research, I ended up connecting with many eating disorder professionals and got my job at the eating disorder program. It was here where I was introduced to “ED”.
I got to observe group sessions and then got to run my own. Every patient is different however one of the common connections all of the patients related to was a “voice” that was constantly in their heads. Meet ED. I eventually imagined a little ugly creature sitting on my patient’s shoulders, feeding them thoughts and ideas, rules and insults, misinformation about themselves, food, their bodies, absolutely everything. This voice (ED) would follow them around all day long, into the night. It never stopped. It was a learning process for me as I learned about how this voice contributes to all of the distortions and beliefs individuals suffering from these eating disorders experience.
Here are some of the things my patients have told me ED says (warning, it will make you sad):
- you can’t have that, it will make you fat
- why did you eat that? you are worthless, you have no willpower!
- don’t listen to her, she is lying, she wants you to gain weight
- white flour is bad
- meat is bad
- you can’t eat fried food
- you can’t have that, it has sugar in it
- you need to burn that up, when are you going to do it? figure it out, you ate it, now you need to get rid of it
- you look fine, they are just jealous because you lost weight. You need to lose more. Don’t listen to them
- you are disgusting
- you didn’t do enough. You need to do more, more laps, more sit-ups, more more more.
Get the picture? Depending on where someone is in the recovery process, talking about this voice does come up. It is a slow process, but helping individuals fight this voice is critical. Exposing ED for the liar that he is takes a lot of work and energy. Of course, every patient needs therapy to work through their specific issues that led to the eating disorder in the first place. As a dietitian, I focus on teaching the truth about foods, eating, weight, etc. Sometimes, during a visit with a patient who is fighting hard and finally aware of what a “healthy” voice is, ED still weasels his way back in. I admit to falling into the trap of arguing with ED, and then it hits me, and I stop. I have often said to patients “wait a minute, I am not going to engage ED, can I talk to YOU?!” Once I had a patient get up and dramatically rip ED from her shoulder and throw him in the waste basket! She said “I have lots of family celebrations this weekend and I want to enjoy them. ED is not invited!” I will never forget that strong visual.
Another thing people don’t often realize is that individuals with eating disorders are just that. Individuals who unfortunately struggle with this disease. They are not an “anorexic” or a “bulimic”. They are people. I have met the most extraordinary people who have had ED on their shoulders and have had to fight him daily. I have met lawyers, dancers, chefs, professors, soccer players, football players, mothers, aunts, fathers, sons, daughters. I have enjoyed getting to know these individuals and especially as ED fades away and they can be their very interesting, fun, loving, energetic and happy selves again. That to me has been rewarding beyond explanation.
And what about you? Unfortunately, I hear people mumbling out loud about food, their bodies, what they ate, exercise, etc. in ways that are not always healthy, and sound way too much like ED. He is a villain that somehow has become culturally acceptable (which makes it real hard for those struggling). Remember, prevention is a lot easier than recovery. When you hear a berating, negative voice in your head about anything to do with eating or your body, just try to be aware. Stop ED in his tracks. Say “you are full of it!” If you can’t stop that voice, you may want to consider getting some help. Maybe someday, our culture will normalize it’s view of eating and body size and he will fade away. Until then, I hope you continue to fight the craziness in your own way.